Obtaining medication histories via telepharmacy: an observational study.

BACKGROUND: Medication reconciliation is an effective strategy to reduce medication errors upon hospital admission. The process involves obtaining a best possible medication history (BPMH), which can be both time-consuming and resource-intensive. During the COVID-19 pandemic, telepharmacy was used to reduce the risk of viral transmission. Telepharmacy is the remote provision of pharmacy-led clinical services, such as obtaining BPMHs, using telecommunications. However, the accuracy of telephone-obtained BPMHs has not yet been evaluated. Therefore, the primary aim of this study was to evaluate the proportion of patients who have an accurate BPMH from the telephone-obtained BPMH compared to an in-person obtained BPMH. METHODS: This prospective, observational study took place in a large tertiary hospital. Recruited patients or carers had their BPMH obtained by a pharmacist over the telephone. The same patients or carers then had their BPMH conducted in-person to identify any deviations between the telephone-obtained and in-person obtained BPMH. All telephone-obtained BPMHs were timed with a stopwatch. Any deviations were categorised according to their potential consequence. An accurate BPMH was defined as having no deviations. Descriptive statistics were used to report all quantitative variables. A multivariable logistic regression was conducted to identify risk factors for patients and medications for having medication deviations. RESULTS: In total, 116 patients were recruited to receive both a telephone-obtained and in-person obtained BPMH. Of these, 91 patients (78%) had an accurate BPMH with no deviations. Of the 1104 medications documented across all the BPMHs, 1064 (96%) had no deviation. Of the 40 (4%) medication deviations, 38 were deemed low-risk (3%) and 2 high-risk (1%). A patient was more likely to have a deviation if they are taking more medications (aOR: 1.11; 95% CI: 1.01-1.22; p < 0.05). A medication was more likely to have a deviation if it was regular non-prescription medication (aOR: 4.82; 95% CI: 2.14-10.82; p < 0.001) or 'when required' non-prescription medication (aOR: 3.12; 95% CI: 1.20-8.11; p = 0.02) or a topical medication (aOR: 12.53; 95% CI: 4.34-42.17; p < 0.001). CONCLUSIONS: Telepharmacy represents a reliable and time-efficient alternative to in-person BPMHs.

Accuracy of best possible medication histories by pharmacy students: an observational study.

BACKGROUND: Medication reconciliation is an effective strategy to prevent medication errors upon hospital admission and requires obtaining a patient's best possible mediation history (BPMH). However, obtaining a BPMH is time-consuming and pharmacy students may assist pharmacists in this task. AIM: To evaluate the proportion of patients who have an accurate BPMH from the pharmacy student-obtained BPMH compared to the pharmacist-obtained BPMH. METHOD: Twelve final-year pharmacy students were trained to obtain BPMHs upon admission at 2 tertiary hospitals and worked in pairs. Each student pair completed one 8-h shift each week for 8 weeks. Students obtained BPMHs for patients taking 5 or more medications. A pharmacist then independently obtained and checked the student BPMH from the same patient for accuracy. Deviations were determined between student-obtained and pharmacist-obtained BMPH. An accurate BPMH was defined as only having no-or-low risk medication deviations. RESULTS: The pharmacy students took BPMHs for 91 patients. Of these, 65 patients (71.4%) had an accurate BPMH. Of the 1170 medications included in patients' BPMH, 1118 (95.6%) were deemed accurate. For the student-obtained BPMHs, they were more likely to be accurate for patients who were older (OR 1.04; 95% CI 1.03-1.06; p < 0.001), had fewer medications (OR 0.85; 95% CI 0.75-0.97; p = 0.02), and if students used two source types (administration and supplier) to obtain the BPMH (OR 1.65; 95% CI 1.09-2.50; p = 0.02). CONCLUSION: It is suitable for final-year pharmacy students to be incorporated into the BPMHs process and for their BPMHs to be verified for accuracy by a pharmacist.

A Conserved Motif in Intracellular Loop 1 Stabilizes the Outward-Facing Conformation of TmrAB.

The ATP binding cassette (ABC) family of transporters moves small molecules (lipids, sugars, peptides, drugs, nutrients) across membranes in nearly all organisms. Transport activity requires conformational switching between inward-facing and outward-facing states driven by ATP-dependent dimerization of two nucleotide binding domains (NBDs). The mechanism that connects ATP binding and hydrolysis in the NBDs to conformational changes in a substrate binding site in the transmembrane domains (TMDs) is currently an outstanding question. Here we use sequence coevolution analyses together with biochemical characterization to investigate the role of a highly conserved region in intracellular loop 1 we define as the GRD motif in coordinating domain rearrangements in the heterodimeric peptide exporter from Thermus thermophilus, TmrAB. Mutations in the GRD motif alter ATPase activity as well as transport. Disulfide crosslinking, evolutionary trace, and evolutionary coupling analysis reveal that these effects are likely due to the destabilization of a network in which the GRD motif in TmrA bridges residues of the Q-loop, X-loop, and ABC motif in the NBDs to residues in the TmrAB peptide substrate binding site, thus providing an avenue for conformational coupling. We further find that disruption of this network in TmrA versus TmrB has different functional consequences, hinting at an intrinsic asymmetry in heterodimeric ABC transporters extending beyond that of the NBDs. These results support a mechanism in which the GRD motifs help coordinate a transition to an outward open conformation, and each half of the transporter likely plays a different role in the conformational cycle of TmrAB.